Improving access to Psychological Therapies

Five health commissioners across Durham and Teesside are working together to re-commission an expanded Improving Access to Psychological Therapies (IAPT) across the region that is safe, equitable and supports people with long-term conditions to maintain good mental wellbeing. The expanded service will be in place by March 2019. To make sure they commission an enhanced and improved service they have used feedback captured during a period of engagement in 2017 to develop a draft model of the new service.

In 2017 the five collaborating health commissioners reviewed current services which included engaging with members of the public, service users, GP’s, stakeholders and providers to capture their views about what the issues were, if any, and how we could improve IAPT services to meet national requirements set out in the Five Year Forward View.

There were a number of themes from the pre-engagement undertaken across the five Clinical Commissioning Groups including suggested improvements to referral processes and timely access, flexibility and choice around support and treatment options, reduced waiting times, improved communication to support attendance at appointments and more responsive step up and step down processes between primary and secondary care, to flexibly manage complex needs.

This feedback has been used to help develop a proposed expanded IAPT model which people will be able to influence further by participating in local focus groups for feedback which are due to be held during Spring 2018.

THE ENGAGEMENT PERIOD IS NOW COMPLETE

During March and April 2018, we will be talked to service users and local stakeholders to gather views about the draft model for the new service. This was to ensure that all views are fed into the proposed expanded IAPT model to deliver the best IAPT service for local people we can. The following public events were held:

Ensure that systems and processes within the expanded IAPT model support patient choice and flexible options for service access and assessment

Ensure that the full range of evidenced-based therapies that fall under IAPT provision are available

Ensure that people are getting access to evidenced-based psychological treatment/interventions at the earliest opportunity

Ensure that treatment/interventions are identified based upon the assessed need of the individual

Ensure that screening and assessment processes are standardised and that all assessments are carried out by an appropriately trained clinician

Provide an IAPT service that proactively supports people with long-term conditions with their mental wellbeing

Background

The Improving Access to Psychological Therapies (IAPT) programme began nationally in 2008 to transform the treatment of adult anxiety disorders and depression in England. Talking therapies are a proven, effective way of helping people with emotional and mental health problems like depression, anxiety and stress. They help work out how to deal with negative thoughts and feelings and make positive changes. The programme now aims to increase the number of people seen and treated from 900,000 in 2015 t0 1.5 million in 2021. An increase of 66% nationally. Two thirds of the expansion will focus on people with long-term conditions including medically unexplained symptoms.

IAPT services are required to provide evidence based psychological therapies that are approved by the National Institute for Health and Care Excellence (NICE). Note that this does not include general counselling.

Current Services

In County Durham and Darlington, IAPT is currently provided by Talking Changes, a joint venture consortium. Separately commissioned general counselling services are also currently available within GP Practices but they do not provide IAPT interventions. A small Medically Unexplained Symptoms service is also available.

The current service for Hartlepool and Stockton-on-Tees and South Tees is provided through an Any Qualified Provider (AQP) model. This means that individuals have a choice about who delivers their IAPT care. Referrals into the service are made by GPs, Tees Esk and Wear Valleys NHSFoundation Trust, secondary healthcare services and through other health and social care sources. However, the majority of people using the services choose to self-refer and are being encouraged to do so through their GP.

What Needs to Change and Why

IAPT services need to change because the Five Year Forward View for Mental Health, by 20/21, expects health commissioners to:

Expand IAPT from seeing a year to date average as at December 2017 of 15.5% of people with anxiety and depression each year across County Durham and Darlington and an average of 20% across Hartlepool, Stockton and South Tees to 25% overall and address the significant variation in access across the collaborative;

Integrate IAPT services with physical health services to provide better support to people with long term conditions and distressing and persistent medically unexplained symptoms

Improve the numbers of people who recover, reducing geographic variation between services, and reducing inequalities in access and outcomes for particular population groups

People with depression and/or anxiety disorders who also have a long-term condition, for example, a respiratory condition, diabetes, chronic pain or medically unexplained symptoms, already access IAPT services but are under-represented.

Treating mental health needs reduces physical health care costs by around 20%and the best outcomes for patients are achieved with adapted treatments that take into account long-term conditions and are embedded into care pathways

Commissioners also need to take into account The GP Five Year Forward View with investment in an extra 3,000 mental health therapists to work in primary care by 2020, which is an average of a full time therapist for every 2-3 typical sized GP practices. It is anticipated that these therapists will come from existing IAPT services.

No additional funding is available to expand the current IAPT model to meet the requirements set out in the Five Year Forward View for Mental Health therefore CCG’s need to look at what they can commission differently.

Commissioning differently means using funding from some services that do not provide IAPT evidence based psychological therapies and re-investing this money into an expanded IAPT service to ensure that local IAPT services in the future will be able to meet the Mental Health Five Year Forward View requirements by 20/21.

Non IAPT approved counselling can still be provided to support people who do not meet the criteria for IAPT, for example stress, anger management and relationship support, but not for people who meet IAPT access criteria.

Local Progress to Date

In April 2017, Hartlepool and Stockton-on-Tees (HaST) and Darlington Clinical Commissioning Groups established an IAPT Project Group to re-design, expand and re-procure an IAPT service across HaST and Darlington Clinical Commissioning Groups, in line with the Mental Health Five Year Forward View. In September 2017, North Durham and Durham Dales, Easington and Sedgefield Clinical Commissioning Groups’ joined the IAPT Project Group to promote collaborative working across the region and reduce duplication in developing and implementing a new IAPT model.

The group are currently in the process of developing a proposed expanded IAPT model in line with national guidance and local needs. Please proposed model below.

A draft proposed model

The Expanded IAPT Service

There are some key elements to the expanded IAPT model. It is proposed that it will:

provide a single point of access into IAPT across five health commissioners, with a standardised screening and assessment

offer co-located physical and mental healthcare as part of an integrated approach to supporting people with long-term conditions providing parity of esteem and a holistic approach to an individual’s physical and mental health needs

provide an expanded range of NICE approved psychological therapies, appropriately adapted to core IAPT and people with long-term conditions

Provide trained IAPT Therapists who have undertaken continued professional development training in supporting people with Long-Term Conditions

offer clear streamlined pathways for step up into secondary care from IAPT and vice versa to help stop patients re-presenting

provide employment support through trained advisors

provide clear identified pathways to ensure individuals are accessing the most appropriate treatment to meet their needs in a timely manner

The new model aims to meet the requirements of the Mental Health Five Year Forward View, offer an enhanced model including people with long-term conditions, a more equitable service across the collaborative and evidence based IAPT interventions that are NICE approved. It will offer the quality of care recommended in the Five Year Forward View and deliver timely evidence based treatment via a Single Point of Access across the collaborative.